Is Omeprazole 20 mg QD and Acetaminophen 325 mg appropriate for a patient with stomach discomfort, heartburn, and an adverse reaction to peanut butter?

Management of Stomach Discomfort, Heartburn, and Adverse Reaction to Peanut Butter

Omeprazole 20 mg once daily is appropriate for treating this patient's heartburn and stomach discomfort, but acetaminophen 325 mg is not specifically indicated, and a food panel lab including nuts is warranted given the clear temporal relationship between peanut butter consumption and diarrhea.

Assessment of Current Symptoms

The 68-year-old male patient presents with:

• Stomach discomfort and heartburn
• Immediate diarrhea following peanut butter consumption
• Recent discontinuation of omeprazole

Appropriate Management Plan

1. Acid Suppression Therapy

Omeprazole 20 mg once daily is the appropriate first-line treatment for this patient's acid-related symptoms:

• Full dose PPI therapy (omeprazole 20 mg once daily) is the first choice for patients with ulcer-like dyspepsia and heartburn 1
• The FDA-approved dosage for symptomatic GERD is omeprazole 20 mg once daily for up to 4 weeks 2
• Omeprazole 20 mg once daily has been shown to effectively control gastric acid and provide symptom relief in patients with heartburn 3

Administration Guidelines:

• Take omeprazole before meals 2
• Morning administration is optimal for acid control 4
• Treatment duration should initially be 4 weeks, with assessment of response 2

2. Food Allergy Evaluation

The immediate onset of diarrhea after peanut butter consumption strongly suggests a food intolerance or allergy:

• A food panel lab including nuts is appropriate given the clear temporal relationship between peanut butter consumption and diarrhea
• This symptom pattern suggests a potential allergic reaction or food intolerance that should be investigated separately from the acid-related symptoms

3. Acetaminophen Consideration

Acetaminophen 325 mg is not specifically indicated for this clinical scenario:

• None of the guidelines recommend acetaminophen for the management of GERD or dyspepsia 1
• The patient's pain appears to be acid-related and would be better addressed with the PPI therapy
• If pain control is needed while awaiting PPI effect, antacids would be more appropriate as they can be used concomitantly with omeprazole 2

Follow-up Plan

1. Short-term follow-up (2-4 weeks):

   • Assess response to omeprazole therapy
   • Review food panel lab results
   • Consider H. pylori testing if symptoms persist 1

2. If symptoms persist despite 4 weeks of therapy:

   • Consider increasing to twice-daily dosing of omeprazole 1
   • Consider endoscopic evaluation if symptoms don't respond to twice-daily PPI therapy 1

Important Clinical Considerations

• Quality of life impact: Treatment with omeprazole has been shown to significantly improve quality of life in patients with heartburn 5
• Potential pitfall: Don't overlook the food-related symptoms as they may represent a separate condition requiring specific management
• Caution: If symptoms persist despite adequate PPI therapy, further evaluation is needed as this could indicate a more serious underlying condition

Remember that the immediate temporal relationship between peanut butter consumption and diarrhea strongly suggests a food intolerance or allergy that requires separate evaluation and management from the acid-related symptoms.